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Cancer Control Research

Wolf, Michael S.


DESCRIPTION (provided by applicant): The overall objective of this study is to improve patient understanding and use of newly prescribed drugs via distribution of `enhanced print' instructions generated by the electronic medical record. More than one third of the 1.5 million adverse drug events that occur in the United States each year happen in outpatient settings. Inadequate sources for patient medication information were specifically cited as a leading root cause, as patients may unintentionally misuse a prescribed drug (Rx) due to improper understanding of instructions. Studies have shown that physicians frequently miss opportunities to adequately counsel patients on how to take prescribed medicines. Prescriptions are also vaguely written, with Latin abbreviations and/or dose frequency schedules that are easily misinterpreted. Pharmacies transcribe these physician prescriptions onto the Rx label, which is then directed to patients. With only limited state/federal regulations, pharmacy interpretations of prescriptions may widely vary. At dispensing, pharmacists do not routinely counsel patients, and print materials accompanying Rx drugs, as well as the vial label, are written in an unclear manner, and difficult for many patients to comprehend. Interventions are needed to standardize and integrate the current fragmented system of patient medication information. We will develop and field test brief, comprehendible instructions at the point of prescribing that will better inform patients about new medicines. Taking advantage of the electronic medical record (EMR), `sig' messages (a.k.a. dosage instructions), will be preset so all physicians prescribe dosage, frequency, and duration in the same clear, simple, and precise manner. `User- friendly' prescriptions will be generated via the EMR and distributed to patients with new medicines. This targeted EMR strategy at the point of prescribing will be able to confirm patients receive adequate drug information, may stimulate physician counseling, and reduce the variability found on Rx labels across pharmacies. Study aims are to: 1) Pilot Test and Refine an EMR protocol for generating and distributing `enhanced print' patient instructions for newly prescribed medicines, 2) Evaluate the efficacy of the `enhanced print' instructions to improve patient understanding of newly prescribed medicines compared to the current standard of care, 3) Investigate the effect of `enhanced print' patient instructions on patient satisfaction, physician behavior, and pharmacy labeling. Evidence-based `sig' messages, warnings and other instructions will be linked to the 100 most-prescribed medicines in one general medicine clinic. The EMR (Epic) interface will be programmed, protocol piloted, and `de-bugged' prior to clinic-wide use. Baseline rates of patient understanding of newly prescribed medicines will be collected prior to roll-out of the refined EMR protocol. Patients with new prescriptions will receive visit summary forms with enhanced print Rx instructions. Rates of patient Rx understanding in the clinic will again be assessed three months later. These patients will also be asked about their filled prescriptions, physician encounters, and satisfaction with enhanced instructions. Public Health Relevance: The proposed study is a significant first step towards improving medication safety through a standard, integrated system of clear and practical patient medication information using health information technology. Results from this line of research will directly inform clinical care and state and federal policies associated with drug labeling and prescribing.

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